The association of ‘total war’, in which the civilian population is heavily and directly involved, with longer-term welfare arrangements is a familiar subject for historians. Links between the domestic war effort, the emergency organisation of national health services and the establishment of a welfare state in Britain are strong, if complex. As the part of mental hospitals and their patients in this context is less obvious and local or grass-roots experiences are comparatively unexplored, St Andrew's offers the opportunity for a case study. There are fewer source materials, however, and wartime records were often compiled less accurately or comprehensively. Under the pressure of events, or from the need to pursue a particular agenda, the standard of ‘on the spot’ assessments may also have slipped. Recognising these deficiencies, this chapter aims to show how St Andrew's Hospital took on additional roles in adverse circumstances and the effect of upheavals and scarcity upon new, temporary and established residents. It suggests that overcrowding and staff shortages were so aggravated in wartime that they assumed crisis proportions in the early years of the National Health Service. Coping with these extraordinary difficulties whilst maintaining the semblance of routine was a demanding task for key hospital personnel. Yet they also began to appreciate that pressures for post-war reform, whilst not dealing fully and directly with mental health care, were nevertheless sweeping them towards an uncertain future.

In many respects the experience of mental hospitals and their patients in the Second World War resembled that of the asylums and their inmates in the First World War. Some hospitals were again evacuated and the essentials of accommodation, food, care and attention, and recreational space for patients were pared down, perhaps below officially acceptable minima, in the face of shortages and overcrowding. The national total of mental hospital patients fell from 133,000 in 1939 to 127,000 early in 1945 but these figures, which excluded armed forces’ patients, reflected displacement by wartime Emergency Medical Service rather than any sudden improvement in treatments. Deprivation was one part of the war experience in which mental hospital patients fully participated, as reviewed in one hour of a parliamentary debate held in November 1945.